Current through Register 1531, September 27, 2024
(A) Each facility,
home health agency, homemaker agency and hospice program shall develop and
adopt, through an interdisciplinary team, written policies and procedures for
preventing patient or resident abuse, neglect, mistreatment and
misappropriation; and reporting and responding to suspected cases of patient or
resident abuse, neglect, mistreatment or misappropriation of patient or
resident property prior to submitting an application for a license. Each
facility, home health agency, homemaker agency and hospice program shall
implement, and review and revise through an interdisciplinary team as needed
but not less than once a year, its written policies and procedures. A facility,
home health agency, homemaker agency and hospice program shall ensure that all
staff, including temporary staff and volunteers, are trained and determined to
be competent as needed for their duties on the policies and procedures
developed. At a minimum, these written policies and procedures shall include
provisions to meet the requirements of 105 CMR 155.010, and the following
areas.
(1) Screening;
(2) Training;
(3) Prevention;
(4) Identification;
(5) Investigation;
(6) Protection; and
(7) Reporting and Response.
(B)
Responsibilities
in Regard to Each Suspected Case. In regard to each case of
suspected patient or resident abuse, neglect, mistreatment or misappropriation
of patient or resident property, each facility, home health agency, homemaker
agency and hospice program shall:
(1) report
all such suspected cases to the Department in accordance with the procedures
set forth in
105 CMR
155.004 and
155.005;
(2) immediately begin to conduct its own
internal investigation into the allegation, interview all witnesses, and obtain
their written statements about the case;
(3) immediately initiate steps to prevent
further potential harm to patients or residents while the investigation is in
progress;
(4) make available to the
Department all information which may be relevant to the Department's
investigation into such suspected cases; and
(5) make all reasonable efforts to facilitate
the Department's attempts to interview any and all potential witnesses who may
have information relevant to the Department's investigation.
(C)
Responsibility to
Review Harmful Incidents. Each facility, home health agency,
homemaker agency, or hospice program shall immediately review any situation or
incident in which a patient or resident suffers physical or psychological
injury or harm for any reason.
(1) If said
review reveals any reasonable basis for believing that patient or resident
abuse, neglect or mistreatment caused, or in any way contributed to, that
injury or harm, the facility, home health agency, homemaker agency or hospice
program shall immediately report the matter to the Department as a case of
suspected abuse, neglect or mistreatment in accordance with the procedures set
forth in
105 CMR
155.004 and
155.005.
(2) In all other cases, in regard to
facilities only, the facility shall report the matter to the Department as an
"incident seriously affecting the health or safety of patients or residents" in
accordance with the requirements of
105 CMR
150.002(G). The Department
shall review such "incident reports" and may in its discretion conduct an
investigation to determine whether resident abuse, neglect or mistreatment had
occurred.
(3) Whenever a patient or
resident has suffered physical or psychological harm as a result of suspected
abuse, neglect or mistreatment, a facility, home health agency, homemaker
agency, or hospice program shall immediately take any and all protective and/or
remedial actions that are reasonably necessary to prevent further harm to that
patient or resident and all other patients and residents. Such protective
and/or remedial action shall not be delayed solely because the Department has
not completed its investigation.
(D)
Responsibility to Provide
Notice.
(1) Each facility shall
post, in a conspicuous location on each floor, a notice informing the public of
the patient and resident abuse statute,
105 CMR 155.000, and the
procedures for reporting to the Department any case of suspected patient or
resident abuse, neglect, mistreatment or misappropriation of patient or
resident property. The form, content and size of the notice shall be prescribed
by the Department.
(2) Each home
health agency, homemaker agency, or hospice program shall post in the
respective agencies' offices a notice informing the public and staff of the
patient abuse statute,
105 CMR 155.000 and the
procedures for reporting to the Department any case of suspected patient abuse,
neglect, mistreatment or misappropriation of patient property. The form,
content and size of the notice shall be prescribed by the Department. Such
agencies shall also inform the patients they serve of the patient abuse
statute, 105 CMR 155.00 and of the procedures for reporting to the Department
any case of suspected patient abuse, neglect, mistreatment or misappropriation
of patient property.
(E)
Responsibility to Contact Registry.
(1) All facilities, except rest homes, shall
contact the Registry prior to hiring a nurse aide in order to determine whether
the prospective employee has met the federal requirements for competency
contained in 42 USC § 1396r and has been certified as a nurse aide for
employment in a facility.
(2) All
facilities shall contact the Registry prior to hiring any employee to ascertain
if there is any sanction, finding or adjudicated finding of patient or resident
abuse, neglect, mistreatment or misappropriation of patient or resident
property against the prospective employee.
(3) All home health agencies, homemaker
agencies, and hospice programs shall contact the Registry prior to hiring an
individual who will provide direct care to patients or have access to patients
or their property to ascertain if there is any sanction, finding or adjudicated
finding of patient or resident abuse, neglect, mistreatment or misappropriation
of patient or resident property against the prospective employee.
(4) Except as provided in
105
CMR 155.014(A)(2), no
facility, home health agency, homemaker agency or hospice program shall hire or
employ an individual whose name appears in the Registry with a finding or
adjudicated finding of patient or resident abuse, neglect, mistreatment or
misappropriation of patient or resident property, or, if a sanction was imposed
upon that individual, such individual may not be hired or employed until the
terms of such sanction have been fulfilled. Furthermore, no facility, home
health agency, homemaker agency or hospice program shall hire or employ an
individual if such individual has been found guilty of, or pleaded guilty or
nolo contendere to, or admitted to sufficient facts to support
a guilty finding of patient or resident abuse, neglect, mistreatment or
misappropriation of patient or resident property in a court of law.
(F)
Provision of
Training. Each facility, home health agency, homemaker agency and
hospice program shall provide orientation and annual in service training
programs for all staff on patient and resident abuse, neglect, mistreatment,
and misappropriation of patient or resident property.
(1) All new employees shall receive
orientation before they begin an assignment to care for a patient or resident.
Such orientation shall include:
(a) provision
of information about the requirements of M.G.L. c. 111, §§ 72F
through 72L, and
105 CMR 155.000;
(b) instruction on the obligation to report
suspected patient or resident abuse, neglect, mistreatment or misappropriation
of patient or resident property, and the reporting procedures as set forth in
105 CMR 155.000;
and
(c) close observation of new
employees.
(2)
Immediately after beginning employment and at least once a year thereafter, all
personnel of facilities, and those personnel of home health agencies, homemaker
agencies and hospice programs who provide services to patients, shall receive
in service training which shall include, but not be limited to, the following:
(a) provision of information about the
requirements of M.G.L. c. 111, §§ 72F through 72L and
105 CMR 155.000;
(b) instruction on the obligation to report
suspected patient or resident abuse, neglect, mistreatment or misappropriation
of patient or resident property, and the reporting procedures as set forth in
105 CMR 155.000;
(c) instruction in techniques for the
management of patients or residents with difficult behavior problems;
(d) identification of factors which
contribute to or escalate patient or resident behavior which is threatening or
assaultive;
(e) assessment of
personal responses to patient or resident behavior which is aggressive,
threatening or assaultive;
(f)
identification and reinforcement of positive and adaptive employee and patient
or resident coping behavior;
(g)
training in the use of intervention techniques, including verbal responses and
safe, non-injurious physical control techniques, as therapeutic tools for
threatening or assaultive patients or residents; and
(h) interdisciplinary program and treatment
planning for patients and residents, as appropriate.
(G)
Adoption of
Preventive Policies. Each facility, home health agency, homemaker
agency and hospice program shall adopt and implement preventive administrative,
management and personnel policies and practices, including, but not limited to,
the following:
(1) careful interviewing of
employee applicants;
(2) close
examination of applicant references prior to hiring;
(3) in accordance with applicable federal and
state laws, obtaining all available criminal offender record information from
the criminal history systems board on an applicant under final consideration
for a position that involves the provision of direct personal care or treatment
to patients or residents.
(4)
cooperation with other facilities, home health agencies, homemaker agencies,
and hospice programs in providing information to prospective employers about an
employee's competence, including the ability to handle patients or residents
with difficult behavioral problems;
(5) staff support programs;
(6) development of patient or resident care
plans which include approaches to dealing with patients or residents who may
exhibit hostile behavior; and
(7)
provision of timely and relevant information to employees regarding patients or
residents who are emotionally unstable or have difficult behavior problems, and
approaches to be used in caring for them.
